In the December 2024 issue of NeoReviews, we published an article titled “Recognition and Impact of Policing Families in the Neonatal Intensive Care Unit.” We highlight the racially patterned history of policing in the US and its hospitals, and provide contemporary solutions relevant to healthcare providers, systems, and our general society.
Policing is a currently contentious, divisive, and politically relevant topic. There are both proponents and opponents of various forms of and the extent of policing. Despite intentions to serve and protect and potential benefits of policing, policing can have negative effects on the physical and mental health of patients, families, and healthcare workers as well as social, legal, and ethical effects on individual and population-level well-being. In the NICU, a place for healing and health promotion during a traumatizing time for families, policing can have significant negative ramifications, including fracturing family-provider relationships, separating families, and compromising health outcomes. Establishing trust and partnering with families may reduce the subjective need for policing and mitigate the harm done by policing.
In this article, we presented a case of a behavioral contract (an agreement drafted by healthcare systems used to police patient behaviors determined to be problematic) and threat of limited visitation placed on a Black mother in the NICU after an emotional display of frustration secondary to repeated poor communication and dismissal of her concerns. Policing in the NICU is an understudied topic, likely due to the taboo and sensitive nature of researching complicated topics. However, this area of research warrants further investigation and attention to increase awareness and resolution. Several recent qualitative studies have provided descriptions of the presence and impact of policing Black families.1–4 Clearly, experiences like the presented case are not isolated to a single NICU or geographical region. Black families in other NICUs are also exposed to policing, surveillance, and delegitimization as parents and parent advocates.3
In two recent qualitative studies written by the present authors dedicated to improving the quality of care provided to Black families and addressing racial inequities in the NICU, families have identified key action areas for NICUs.3,4 Families shared experiences that provided evidence of an untrustworthy system, rather than narratives that place blame and ownership on families or label them as mistrusting. Families provided recommendations to build trust at different levels, including:
- Interpersonal: communication transparency, inclusive decision making, and redistribution of power by treating families as true care partners through orientation, education, and support rather than disciplinary action;
- Institutional: policies to decrease inequitable resource allocation, improve mental health access and support, and transformation of space and staff to promote humanism and inclusion; and
- Sociocultural: methods to diversify the workforce and mitigate harm experienced within and outside the NICU through peer support and resource allocation.
The care of an infant extends beyond the immediate patient and includes the entire family unit. Focusing on authentic family-centered, non-punitive care that is both trauma informed and culturally respectful is paramount to the health and well-being of our patients, families, and communities. Action can and should be taken at multiple levels to decrease the amount of surveillance and policing of racially marginalized families. In our article, we highlight these actions across individual, institutional, and societal governing bodies (Table). In addition, future research to understand the reach and downstream consequences of policing in the NICU will be critical to identify successful tactics to support rather than punish families under extraordinary stress.
References
- Ajayi KV, Page R, Montour T, Garney WR, Wachira E, Adeyemi L. ‘We are suffering. Nothing is changing.’ Black mother’s experiences, communication, and support in the neonatal intensive care unit in the United States: A Qualitative Study. Ethnicity & Health. Published online September 21, 2023:1-23. doi:10.1080/13557858.2023.2259642
- Witt RE, Malcolm M, Colvin BN, et al. Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers. Pediatrics. 2022;150(3):e2022056971. doi:10.1542/peds.2022-056971
- Ondusko DS, Klawetter S, Hawkins Carter E, et al. The Needs and Experiences of Black Families in the Neonatal Intensive Care Unit. Pediatrics. Published online December 19, 2024:e2024067473. doi:10.1542/peds.2024-067473
- Karvonen KL, Smith O, Chambers Butcher BD, et al. Parent and staff focus groups to address NICU racial inequities: “There’s radical optimism in that we’re in a different time and we’re not doing it alone.” The Journal of Perinatology.